Emergency Preparedness - A Review of the Literature

[Update, 12-01: fixed a couple of formatting errors. I'll have to make my way through Drak Wraith's "HTML for Bloggers" course...]

Note: This is Part One of a multi-part series examining the state of emergency preparedness in the United States, especially as it affects ordinary citizens.

I’ve been bitching a lot recently about DHS (Department of Homeland Security), its subordinate agencies and directorates, and the generally poor state of emergency preparedness. It occurred to me, however, that I might have been alone in those estimations, so I decided to undertake what the academics refer to as “a review of the current literature”, to see what other practitioners had to say.

First, in the current issue of The Internet Journal of Rescue and Disaster Medicine, Eric R. Taylor, Ph.D. (University of Louisiana at Lafayette) examines the two versions of FEMA’s much ballyhooed citizen’s disaster manual, Are You Ready? Both editions – the original, and an updated “In-Depth” version – claim to provide definitive information for citizens in the event of technological or natural disasters. [All emphasis added]

I will follow Taylor’s headings in this article, just in case the reader wants to verify quotes, etc.

From the abstract to Dr. Taylor’s article:

The FEMA document for terrorism preparedness intended for use by the public does not offer useful information the public can use to actively take steps in their own defense and protection against weapons agents that may confront them in an active terrorist attack. The public remains unprepared to act on their own behalf, and by the time official notice of an attack in determined and announced, many people may suffer injury or die for lack of realistic preparation.

This, despite FEMA’s exhortation:

“... don't wait until disaster strikes before you tell the people what to do. Your motto should be the same as the scouts. You want the people to BE PREPARED!”

Introduction

Dr. Taylor asserts that the American populace has been conditioned to that the government can “care for them, defend them, assist them in virtually any phase of social and natural disasters and assaults that come their way”. He adds, however, “It should be painfully clear now that government cannot do so” and that “the primary document advanced by FEMA does a poor job of educating the public on terrorism related preparedness.”

U.S. Terrorism Preparation

Taylor initially discusses the overall terrorism preparedness posture, making the following points:

• “It is the public that is now in need of useful, do-able information for preparing and responding to a terrorist attack, especially WMCD [1]”
• “What is needed is a single source of information written in a form and at a level of technical depth designed for the general public in a single source document from a single federal agency.”

Taylor further cites the testimony of government officials before the Senate Select Committee on Intelligence hearings in February, 2005. Vice Admiral Lowell E. Jacoby, Director of the Defense Intelligence Agency (DIA) addressed al Qaeda’s capability to employ and deliver unconventional weapons, saying, “Because they are easier to employ, we believe terrorists are more likely to use biological agents such as ricin or botulinum toxin or toxic industrial chemicals to cause casualties and attack the psyche of the targeted populations.” This is particularly disturbing in light of the repercussions of several recent haz-mat (hazardous materials) incidents recently, such as the Apex fire or the Graniteville train derailment, both of which resulted in fatalities, wide-spread evacuations, release of toxic chemicals into the atmosphere, and significant property loss.

Porter Goss, Director of the CIA, said, “al Qaeda is intent on finding ways to circumvent U.S. security enhancements to strike Americans and the Homeland [sic].” As I have pointed out (along with many others), the “security enhancements” to which Goss refers are virtually non-existent. Rail yards full of toxic chemicals are left wide open and unguarded, less than six percent of the freight containers entering the county from overseas are inspected [2], the food chain is virtually defenseless, the public water supply ditto. The screw-ups at TSA can catch nail clippers and shampoo, but manage to miss bombs (fake, thank God) in carry-on luggage.

Nature of the Threat

Taylor posits, however, that “nothing offers a greater long-term hazard and threat on a more likely level of occurrence than bioterrorism….”, adding, “If the technical know-how, or the actual agent samples fall into the wrong hands (such as rogue states and/or through them, terrorists), our safety is seriously compromised by these “artificial” and virulent agents for which no human has any natural resistance and no medical practitioner has the means to fight.”

Unfortunately, we may ourselves be supplying the technical know-how to those who wish us harm. Thousands of international students – many from Muslim countries – study at American universities. Obviously, the vast majority of these students are simply interested in learning and bettering the world as a whole. But there is a small percentage – certainly less than 1% overall – who want to use our knowledge against us (witness Atta and his cohorts taking flight lessons in American flight schools). And don’t think that immigration and border control authorities are doing anything to stem the flow. I used to work for a university police department, and I can tell you from experience, visa control and enforcement is a joke. The federal agencies have neither the manpower nor the budget to effectively track the thousands of alien students, while the universities turn a blind eye in the interests of tuition income.

FEMA’s Public Terrorism Education

In reviewing the first edition of Are You Ready?, Taylor highlights many problems:

• The initial guide “was fraught with brevity that bordered on uselessness for the technological material, especially the terrorism and WMCD It also overlooked more commonly useful items for implementation of its recommendations for action, and in some cases offered potentially hazardous information if carried out by the public.”
• “A comparison of the two different versions reveals the overall inadequacies of the approach FEMA took, and retained in the latest version available to the public.”
• “The Shelter section advised making an emergency toilet if necessary. It suggested sprinkling a household disinfectant such as household bleach into the container to reduce odor and germs. As anyone who has read the label of a bleach bottle (or an ammonia bottle) knows, the warning is quite specific and emphatic: DO NOT MIX BLEACH with AMMONIA. Human urine contains ammonia and will generate more on standing. The bleach added to ammonia- generating materials can produce any one or all of several poisonous chemicals (chlorine, nitrogen trichloride, or hydrazine) depending upon the proportions and concentrations of bleach and urine-based ammonia, mixture temperature and standing time. The recommendation served to replace the obnoxious with the noxious. These poisonous by-products are potent respiratory irritants. This problem is increased by many people utilizing the same receptacle repeatedly over time in a presumably confined, unventilated space. The fumes can build up very quickly.”

The last emphasized portion deserves repeating:

The recommendation served to replace the obnoxious with the noxious.

Back to Taylor’s review of the first edition:

• “The same section of the initial guide also notes that water can be purified by distillation. The means suggested– placing a cup under an inverted lid within a pot of boiling water– seems clumsy, probably hazardous to perform, but certainly inefficient, not to mention energy and time consuming for very meager returns. The last thing those in an emergency situation need is a second or third degree burn from distilling water. Distilling enough water this way for a few people to serve their minimum daily needs is doubtful. If you lose electricity or natural gas through the incident, you can't distill anyway.”

The In-Depth August 2004 Guide

Moving on to the second, “in-depth” 2004 edition, Taylor notes: [Citations omitted]

• “The Chemical Threat section of the In-Depth Guide does not even mention the four types of lethal chemical weapons. It does not indicate the relative rapidity of action of one class to another. It does offer a string of signs or symptoms of lethal chemical weapons employment in a terrorist attack. But the string of symptoms are generic, could be in some cases those of allergic responses, and suggests by its manner of presentation that they may all become present. There is no elaboration of any kind to offer agent class specificity. This in what is called an In-Depth guide. And the same cite makes the statement, while potentially lethal, chemical agents are difficult to deliver in lethal concentrations. This is an unjustified generalization that is disarmingly misleading and false. Both the original Guide and the In-Depth Guide state that chemical agents are difficult to produce. This is patently false. Chemical agents were originally made and used in WWI and they were made and used specifically because they were made from exiting industrial chemical precursors, cheap to make and within handling safety considerations, easy to make and use.”
• “The section [on biological threats] refers the reader to the Centers for Disease Control and Prevention (CDC) website (www.cdc.gov) for specific information. . . . . Much of the available information is primarily for professionals rather than lay people and may be rather technical for them. The problem with referring readers of the In-Depth guide (hardcopy) to a website is that many people may not have web access.”
• “[E]xposure to levels of chemical agent that may be sublethal to adults may well be lethal to children and pets as lethal dose is body weight dependent (LD50). This of necessity brings into play the need and concern for personal residences decontamination and especially surfaces outside that are frequented by all, especially children and pets. FEMA's In-Depth guide offers no advise on how to deal with this likely problem, much less how to undertake necessary hasty decontamination of residential exterior surfaces and what to use for doing so.”
• “The current FEMA In-Depth guide does avoid the technically overwhelming feature. It also avoids the completeness, the thoroughness, the robustness required of a document purported to be In-Depth….”
• “Many people bought “gas” […] masks as respiratory protection during the anthrax-mail attacks. […] The typical American has no idea of how to assess the appropriateness or serviceability of the mask or the filter elements.”

Perhaps Dr. Taylor’s most telling comment is this:

“After tens of billions of dollars spent on terrorism preparedness, with hundreds of expert chemists, biologists, physicists, and physicians on the government payroll, FEMA's In-Depth Guide is the best the federal government can offer the public? The public may face serious trouble ahead.”

In subsequent parts of this series, we’ll look at what others in the emergency response community have to say about the overall preparedness posture.

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[1] Taylor prefers the term “weapons of mass casualty and destruction”, over the government’s preferred “WMD” or CBRNE, which stands for Chemical, Biological, Radiological, Nuclear and Explosive.

[2] Anderson, Teresa. “Cargo Security: Containing Cargo Risk” Security Management, Sept, 2005